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Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
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Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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2
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Bandopadhyay A, Kapoor A, Kundu K, Jagtap M, Chattopadhyay D. Translation and validation of Hindi version of patient scar assessment scale in patients with postburn facial scar. J Cutan Aesthet Surg 2024; 17:55-59. [PMID: 38736860 PMCID: PMC11086925 DOI: 10.4103/jcas.jcas_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study was to translate and validate the PSAS to Hindi. Materials and Methods We did forward and backward translation of the English PSAS together with its validation. In total, 64 patients with postburn facial scars were included. The validation committee consisted of 6 bilingual members. Results The PSAS-Hindi showed good internal consistency with Cronbach's α of 0.86. Test-retest reliability showed good correlation with intra class coefficient being 0.94 (95% confidence interval: 0.83-0.97). Conclusion The PSAS was successfully translated to Hindi, and cross-cultural adaptation was made.
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Affiliation(s)
- Arkapal Bandopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustav Kundu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Jagtap
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Yue S, Ju M, Su Z. A Systematic Review And Meta-Analysis: Botulinum Toxin A Effect on Postoperative Facial Scar Prevention. Aesthetic Plast Surg 2022; 46:395-405. [PMID: 34609526 DOI: 10.1007/s00266-021-02596-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Postoperative facial scarring can be a significant psychological burden for patients to carry after surgery, often resulting in prolonged mental health dysfunction. Currently, there is no established method to prevent facial scar formation; however, there are several methods to prevent facial scar hyperplasia and improve scar quality. Botulinum toxin A (BTA) has been widely used due to its properties of muscle paralysis and known success in plastic surgery and cosmetology. This meta-analysis aimed to evaluate the efficacy of BTA in preventing postoperative facial scar hyperplasia and improving scar quality. METHODS PubMed, MEDLINE, EMBASE, web of science, and Cochrane libraries were searched for randomized controlled trials (RCTs) (published before May 2021) wherein BTA was used for the treatment of facial scars. The efficacy and safety of BTA were evaluated by the following scales: the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Observer Scar Assessment Scale (OSAS), Patient Scar Assessment Scale (PSAS), and Stony Brook Scar Evaluation Scale (SBSES); the BTA effect on scar width and complications was also assessed. RESULTS Ten RCTs involving 114 cases were included. Through quantitative analysis, the BTA injection group had a higher VAS score, lower VSS score, lower OSAS score, and smaller scar width. However, no significant difference was noted in the incidence of postoperative complications between the two groups. CONCLUSIONS This meta-analysis demonstrated that BTA can safely improve the appearance of postoperative facial scars by significantly inhibiting scar hyperplasia and improving scar quality. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Shuai Yue
- Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, China.
| | - Mengran Ju
- Department of Plastic and Reconstructive Surgery, Chengdu Badachu Medical Aesthetics Hospital, Chengdu, 610000, China
| | - Zhe Su
- Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing, 100730, China
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4
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Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Response to Vercelli et al. re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis". J Altern Complement Med 2021; 27:374-376. [PMID: 33826859 DOI: 10.1089/acm.2020.29089.cde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlina Deflorin
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Erich Hohenauer
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland
| | - Rahel Stoop
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Ulrike van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Oscare, Organization for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Ron Clijsen
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland.,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
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Ahn D, Lee GJ, Sohn JH. Individualized Use of Facelift, Retroauricular Hairline, and V-Shaped Incisions for Parotidectomy. J Oral Maxillofac Surg 2020; 78:2339.e1-2339.e8. [PMID: 32949504 DOI: 10.1016/j.joms.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 08/19/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Despite the increased need for better cosmetic outcomes following parotidectomy, there is no study on the individualized use of esthetic approaches for parotidectomy. We aimed to evaluate the feasibility of individualzsed esthetic approaches for parotidectomy using facelift (FL), retroauricular hairline (RAH), and V-shaped incisions, and compare their surgical and cosmetic outcomes. METHODS This was a retrospective cohort study. Between 2015 and 2019, we included patients who underwent parotidectomy using FL, RAH, and V-shaped incisions for the treatment of benign parotid tumors. The surgical approach for parotidectomy was determined based on tumor location and each patient's cosmetic demand, following a comprehensive discussion of available esthetic approaches. Surgical and cosmetic outcomes were assessed as primary outcome variables, which were compared among the 3 incision groups. One-way analysis of variance/Kruskal-Wallis test and the chi-squared test were used to inspect differences in continuous and categorical variables, respectively, among the groups. RESULTS A total of 213 patients, consisting of 122, 50, and 41 patients in the FL, RAH, and V-shaped groups, respectively, were included in the present study. In the FL, RAH, and V-shaped groups, the patient age was 53.5, 51.8, and 42.1 years, respectively (P < .001), and the tumor size was 2.8, 2.7, and 1.9 cm, respectively (P < .001). All parotidectomies were successfully completed with no incision extension or major complications. The subjective scar satisfaction scores assessed at 3 months postoperatively were 8.5, 9.1, 9.2 in the FL, RAH, and V-shaped groups, respectively (P < .001). However, the Vancouver scar scale was consistent across all groups. CONCLUSIONS Individualized use of esthetic approaches for parotidectomy is feasible and yields improved cosmetic results, leading to high patient satisfaction. Although FL incision is still the standard approach for esthetic parotidectomy, both RAH and the V-shaped incisions could further enhance the cosmetic outcomes of parotidectomy.
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Affiliation(s)
- Dongbin Ahn
- Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea.
| | - Gil Joon Lee
- Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
| | - Jin Ho Sohn
- Professor & Department Head, Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea
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Kim SH, Lee SJ, Lee JW, Jeong HS, Suh IS. Clinical trial to evaluate the efficacy of botulinum toxin type A injection for reducing scars in patients with forehead laceration: A double-blinded, randomized controlled study. Medicine (Baltimore) 2019; 98:e16952. [PMID: 31441893 PMCID: PMC6716761 DOI: 10.1097/md.0000000000016952] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) is known to prevent fibroblast proliferation and expression of transforming growth factor beta 1 (TGF-β1). It also induces temporary muscle paralysis and decreases tension vectors. Fibroblasts induce scar contracture and hypertrophy by producing collagen fibers in wound healing processes. The aim of this study is to identify the effect of BoNTA on the scar formation. METHODS Forty-five patients with forehead laceration were enrolled in this study and randomized into 2 groups with or without injection of BoNTA. When the patients presented to the clinic to remove the stitches, BoNTA was injected to the BoNTA group with 24 patients and saline was injected to the control group with 21 patients. The BoNTA was injected on dermal layer with 5 IU/cm. After that, follow-up was done in 1, 3, and 6 months. The scars were analyzed with the patient and observer scar assessment scale, Stony Brook scar evaluation scales (SBSESs), and visual analog scale (VAS) and analyzed with independent T-test, along with clinical photographs, cutometer, and biopsies. RESULTS In all scar scales, the scores changed into favorable direction in both groups and the changes were larger in BoNTA group compared with the control group. On SBSES and VAS, better improvements on BoNTA group showed statistical significance. Skin biopsy showed less collagen deposition on dermal layer in BoNTA group. CONCLUSION Improvement of aesthetic, functional, and emotional aspect of the scar formation in the groups treated with BoNTA was illustrated. The application of BoNTA may be expanded to prevent hypertrophic scar after trauma, burns, or operations.
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Zhou Y, Tang S, Cao Y, Zhang J. [Application of transcutaneous oxygen pressure in scar assessment]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1615-1618. [PMID: 30569693 DOI: 10.7507/1002-1892.201810098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the application and research progress of transcutaneous oxygen pressure (TcPO 2) in scar assessment. Methods The original articles about scar and TcPO 2 were reviewed and analyzed. Results Hypoxia environment plays an important role in the progression of scar tissue. TcPO 2 can accurately reflect the oxygen tension of scar tissue, which is of great significance in the assessment of scar maturity, the guidance of scar treatment, and the study of correlations between hypoxia and the progression of scar. Conclusion TcPO 2 measurement is important in the study of scar evaluation, treatment, and correlation between hypoxia and scar formation.
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Affiliation(s)
- Yi Zhou
- Nanjing Medical University, Nanjing Jiangsu, 211166, P.R.China
| | - Songjia Tang
- Department of Medical Cosmetology, the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310006, P.R.China
| | - Yilin Cao
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, P.R.China
| | - Jufang Zhang
- Department of Medical Cosmetology, the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou Zhejiang, 310006,
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8
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Feasibility of a new V-shaped incision for parotidectomy: a preliminary report. Br J Oral Maxillofac Surg 2018; 56:406-410. [DOI: 10.1016/j.bjoms.2018.03.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
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9
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Nanchahal J, Ball C, Swettenham J, Dutton S, Barber V, Black J, Copsey B, Dritsaki M, Taylor P, Gray A, Feldmann M, Lamb S. Study protocol: A multi-centre, double blind, randomised, placebo-controlled, parallel group, phase II trial (RIDD) to determine the efficacy of intra-nodular injection of anti-TNF to control disease progression in early Dupuytren's disease, with an embedded dose response study. Wellcome Open Res 2017; 2:37. [PMID: 29218326 PMCID: PMC5701439 DOI: 10.12688/wellcomeopenres.11466.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 11/20/2022] Open
Abstract
Dupuytren's disease is a common fibrotic condition of the hand affecting 4% of the population and causes the fingers to curl irreversibly into the palm. It has a strong familial tendency, there is no approved treatment for early stage disease, and patients with established digital contractures are most commonly treated by surgery. This is associated with prolonged recovery, and less invasive techniques have high recurrence rates. The myofibroblasts, the cells responsible for the excessive matrix deposition and contraction, are aggregated in nodules. Using excised diseased and control human tissue, we found that immune cells interspersed amongst the myofibroblasts secrete cytokines. Of these, only tumour necrosis factor (TNF) promoted the development of myofibroblasts. The clinically approved anti-TNF agents led to inhibition of the myofibroblast phenotype in vitro. This clinical trial is designed to assess the efficacy of the anti-TNF agent adalimumab on participants with early disease. The first part is a dose-ranging study where nodules of participants already scheduled for surgery will be injected with either placebo (saline) or varying doses of adalimumab. The excised tissue will then be analysed for markers of myofibroblast activity. The second part of the study will recruit participants with early stage disease. They will be randomised 1: 1 to receive either adalimumab or placebo at 3 month intervals over 1 year and will then be followed for a further 6 months. Outcome measures will include nodule hardness, size and disease progression. The trial will also determine the cost-effectiveness of adalimumb treatment for this group of participants.
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Affiliation(s)
- Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK
| | - Catherine Ball
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK
| | - Jennifer Swettenham
- Kennedy Institute of Rheumatology, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, UK
| | - Susan Dutton
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Vicki Barber
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Joanna Black
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Bethan Copsey
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Melina Dritsaki
- Oxford Clinical Trials Research Unit, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Peter Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road, Oxford, OX3 7LF, UK
| | - Marc Feldmann
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LDR, UK
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Nanchahal J, Ball C, Swettenham J, Dutton S, Barber V, Black J, Copsey B, Dritsaki M, Taylor P, Gray A, Feldmann M, Lamb S. Study protocol: A multi-centre, double blind, randomised, placebo-controlled, parallel group, phase II trial (RIDD) to determine the efficacy of intra-nodular injection of anti-TNF to control disease progression in early Dupuytren’s disease, with an embedded dose response study. Wellcome Open Res 2017; 2:37. [DOI: 10.12688/wellcomeopenres.11466.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/20/2022] Open
Abstract
Dupuytren’s disease is a common fibrotic condition of the hand affecting 4% of the population and causes the fingers to curl irreversibly into the palm. It has a strong familial tendency, there is no approved treatment for early stage disease, and patients with established digital contractures are most commonly treated by surgery. This is associated with prolonged recovery, and less invasive techniques have high recurrence rates.The myofibroblasts, the cells responsible for the excessive matrix deposition and contraction, are aggregated in nodules. Using excised diseased and control human tissue, we found that immune cells interspersed amongst the myofibroblasts secrete cytokines. Of these, only tumour necrosis factor (TNF) promoted the development of myofibroblasts. The clinically approved anti-TNF agents led to inhibition of the myofibroblast phenotype in vitro. This clinical trial is designed to assess the efficacy of the anti-TNF agent adalimumab on participants with early disease. The first part is a dose-ranging study where nodules of participants already scheduled for surgery will be injected with either placebo (saline) or varying doses of adalimumab. The excised tissue will then be analysed for markers of myofibroblast activity.The second part of the study will recruit participants with early stage disease. They will be randomised 1: 1 to receive either adalimumab or placebo at 3 month intervals over 1 year and will then be followed for a further 6 months. Outcome measures will include nodule hardness, size and disease progression. The trial will also determine the cost-effectiveness of adalimumb treatment for this group of participants.
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11
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Kantor J. The SCAR (Scar Cosmesis Assessment and Rating) scale: development and validation of a new outcome measure for postoperative scar assessment. Br J Dermatol 2016; 175:1394-1396. [PMID: 27292082 DOI: 10.1111/bjd.14812] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Kantor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Florida Center for Dermatology, P.A., PO Box 3044, Saint Augustine, FL, 32085, U.S.A
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12
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Karamese M, Akdag O, Selimoglu MN, Unal Yıldıran G, Tosun Z. V-Y and rectangular flap combination for syndactyly repair. J Plast Surg Hand Surg 2015; 50:102-6. [PMID: 26541805 DOI: 10.3109/2000656x.2015.1106409] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE For syndactyly repair, several delicate, well-planned flap combination techniques have been reported. This study presents technique details with functional and aesthetic results of a dorsal rectangular and volar V-Y advancement flap combination for web reconstruction and S incisions for finger separation in patients with syndactyly. METHOD Ten patients with 16 syndactyly webs were treated. Patients were examined in terms of function and aesthetic. Evaluation criteria included the Vancouver Scar Scale, range of motion, degree of web creeping, parent's satisfaction rates, and finger abduction. During the initial period, vascular compromise of fingers, haematoma, infection, seroma, flap necrosis, or graft failures were not noted in any patients. No patients required revision surgery. During the later period, parent satisfaction scores were excellent or good, finger function was complete, and the Vancouver Scar Scale showed that two webs had hyperpigmented areas and two had supple pliability. CONCLUSION This simple syndactyly release technique can provide a low rate of web creep, good scar quality, and optimal functional results.
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Affiliation(s)
- Mehtap Karamese
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Osman Akdag
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Muhammed Nebil Selimoglu
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Gokce Unal Yıldıran
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
| | - Zekeriya Tosun
- a Selcuk University , Department of Plastic Reconstructive and Aesthetic Surgery , Konya , Turkey
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13
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van der Wal MBA, Vloemans JFPM, Tuinebreijer WE, van de Ven P, van Unen E, van Zuijlen PPM, Middelkoop E. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring. Wound Repair Regen 2013; 20:676-87. [PMID: 22985039 DOI: 10.1111/j.1524-475x.2012.00820.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively.
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14
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Ziade M, Domergue S, Batifol D, Jreige R, Sebbane M, Goudot P, Yachouh J. Use of botulinum toxin type A to improve treatment of facial wounds: a prospective randomised study. J Plast Reconstr Aesthet Surg 2012; 66:209-14. [PMID: 23102873 DOI: 10.1016/j.bjps.2012.09.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 08/06/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND The tension vectors acting on the wound edges are transmitted to immature collagen fibres synthesised during the normal healing phase. This accounts for scar widening as well as hypertrophic and hyperpigmented scars. The aim of our study was to evaluate whether early injections of botulinum toxin type A (BTA), which induces temporary muscular paralysis, decreases tension vectors on wound edges and enhances scarring of facial wounds. PATIENTS AND METHODS Thirty patients with facial wounds were enrolled in this study and randomised into two groups with or without injection of BTA within 72 h postoperatively. BTA was injected into the facial muscles directly or indirectly involved in scar widening. Scars were assessed at a 1-year follow-up visit by patients using the Patient Scar Assessment Scale (PSAS) scale, by an independent evaluator using the Observer Scar Assessment Scale (OSAS) and the Vancouver Scar Scale (VSS), and by a board of six experienced medical specialists using the Visual Analogue Scale (VAS) with standardised photographs. RESULTS At the 1-year visit, 24 patients were reviewed and six patients were lost to follow-up. No statistically significant differences were found between the two groups for the PSAS, OSAS and VSS scores. However, the median VAS rated by the six evaluators was 8.25 for the botulinum toxin-treated group compared with 6.35 for the control group. This result was statistically different, demonstrating improved scarring with BTA. CONCLUSIONS Thanks to chemoimmobilisation, injections of BTA appear to improve cosmesis of facial wounds. Accordingly, they would be beneficial for use in young patients for wounds without tissue loss, lying perpendicular to the reduced tension lines of the skin of the face.
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Affiliation(s)
- Makram Ziade
- Department of Plastic and Reconstructive Surgery, Lapeyronie University Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier, France.
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Rasch analysis of the Patient and Observer Scar Assessment Scale (POSAS) in burn scars. Qual Life Res 2011; 21:13-23. [PMID: 21598065 PMCID: PMC3254877 DOI: 10.1007/s11136-011-9924-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2011] [Indexed: 11/03/2022]
Abstract
PURPOSE The Patient and Observer Scar Assessment Scale (POSAS) is a questionnaire that was developed to assess scar quality. It consists of two separate six-item scales (Observer Scale and Patient Scale), both of which are scored on a 10-point rating scale. After many years of experience with this scale in burn scar assessment, it is appropriate to examine its psychometric properties using Rasch analysis. METHODS Cross-sectional data collection from seven clinical trials resulted in a data set of 1,629 observer scores and 1,427 patient scores of burn scars. We examined the person-item map, item fit statistics, reliability, response category ordering, and dimensionality of the POSAS. RESULTS The POSAS showed an adequate fit to the Rasch model, except for the item surface area. Person reliability of the Observer Scale and Patient Scale was 0.82 and 0.77, respectively. Dimensionality analysis revealed that the unexplained variance by the first contrast of both scales was 1.7 units. Spearman correlation between the Observer Scale Rasch measure and the overall opinion of the clinician was 0.75. CONCLUSION The Rasch model demonstrated that the POSAS is a reliable and valid scale that measures the single-construct scar quality.
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Kaartinen IS, Välisuo PO, Bochko V, Alander JT, Kuokkanen HO. How to assess scar hypertrophy--a comparison of subjective scales and Spectrocutometry: a new objective method. Wound Repair Regen 2011; 19:316-23. [PMID: 21518084 DOI: 10.1111/j.1524-475x.2011.00679.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Scar hypertrophy is a significant clinical problem involving both linear scars from elective surgery and scars caused by trauma or burns. The treatment of hypertrophic scars is often time consuming, and patients may need to be followed up for months or even years. The methods for reliable quantification of scar hypertrophy are at present unsatisfying. We have developed a new, objective method, Spectrocutometry, for documentation and quantification of scar hypertrophy. The instrument is based on standardized digital imaging and spectral modeling and calculates the estimated concentration change of hemoglobin and melanin from the entire scar and also provides standardized images for documentation. Three plastic surgeons have assessed 37 scars from melanoma surgery using Spectrocutometry, the Vancouver scar scale, and the patient and observer scar assessment scale. The intraclass correlation coefficient for the Vancouver scar scale and the patient and observer scar assessment scale was lower than required for reliable assessment (r=0.66 and 0.60, respectively). The intraclass correlation coefficient for Spectrocutometry was high (r=0.89 and 0.88). A Bayesian network analysis revealed a strong dependency between the estimated concentration change of hemoglobin and scar pain. Spectrocutometry is a feasible method for measuring scar hypertrophy. It is shown to be more reliable than subjective rating in assessing linear surgical scars.
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Affiliation(s)
- Ilkka S Kaartinen
- Department of Plastic Surgery, Tampere University Hospital, Tampere, Finland.
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Stavrou D, Weissman O, Winkler E, Yankelson L, Millet E, Mushin OP, Liran A, Haik J. Silicone-based scar therapy: a review of the literature. Aesthetic Plast Surg 2010; 34:646-51. [PMID: 20354695 DOI: 10.1007/s00266-010-9496-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 03/03/2010] [Indexed: 11/29/2022]
Abstract
Hypertrophic and keloid scars still are among the banes of plastic surgery. In the treatment arsenal at the disposal of the plastic surgeon, topical silicone therapy usually is considered the first line of treatment or as an adjuvant to other treatment methods. Yet, knowledge concerning its mechanisms of action, clinical efficacy, and possible adverse effects is rather obscure and sometimes conflicting. This review briefly summarizes the existing literature regarding the silicone elastomer's mechanism of action on scars, the clinical trials regarding its efficacy, a description of some controversial points and contradicting evidence, and possible adverse effects of this treatment method. Topical silicone therapy probably will continue to be the preferred first-line treatment for hypertrophic scars due to its availability, price, ease of application, lack of serious adverse effects, and relative efficacy. Hopefully, future randomized clinical trials will help to clarify its exact clinical efficacy and appropriate treatment protocols to optimize treatment results.
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Affiliation(s)
- Demetris Stavrou
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Candy LHY, Cecilia LTWP, Ping ZY. Effect of different pressure magnitudes on hypertrophic scar in a Chinese population. Burns 2010; 36:1234-41. [PMID: 20541324 DOI: 10.1016/j.burns.2010.05.008] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/06/2010] [Accepted: 05/12/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study aimed to investigate the effect of different pressure magnitudes on treatment outcomes of hypertrophic scars, and determine pressure loss over time. METHODS A randomized clinical trial was adopted. 53 hypertrophic scar samples from 17 Chinese participants were recruited and randomly assigned into a high pressure group (20-25 mmHg) and low pressure group (10-15 mmHg) for a five-month intervention program. The scars were assessed objectively before intervention and monthly after intervention for thickness, color (redness, yellowness and lightness) and scar pliability. Pressure magnitude at each assessment was also measured. Two-way repeated ANOVA was used to compare for differences between groups. RESULTS The results showed that both levels of pressure produced reduction in scar thickness and redness, but the improvement in the high pressure group was statistically better than that of the counterpart (both p<0.05). Monthly pressure measurement revealed that pressure loss in the high pressure group was more severe. However, no major changes in other color parameters and pliability were observed for both the groups. CONCLUSION High pressure was demonstrated to be more effective for scar management, but it was also more prone to higher pressure loss. Pressure therapy integrated with regular monitoring of the interface pressure is suggested to improve its therapeutic efficacy.
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Affiliation(s)
- Lai Hoi Yan Candy
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F. How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 2010; 31:2055-63. [PMID: 19888834 DOI: 10.3109/09638280902874196] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Complications of surgical incision include pathological scars with functional, cosmetic or psychological consequences. Postsurgical scar assessment is fundamental for a complete functional evaluation and as an outcome measure. Scar assessment scales are here reviewed and discussed from a clinical and psychometric point of view, with a clear definition of different scar parameters. METHOD An extensive review of the English-language literature was conducted using the Medline database. RESULTS Four scales that satisfy psychometrical criteria were identified: Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), Manchester Scar Scale (MSS) and Stony Brook Scar Evaluation Scale (SBSES). CONCLUSIONS To date, VSS is the most widely used rating scale for scars but POSAS appears the most comprehensive, taking into account the important aspect of patient's perspective. The MSS has been never used for research, while SBSES has only been very recently proposed.
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Affiliation(s)
- Stefano Vercelli
- Fondazione Salvatore Maugeri, Unit of Occupational Rehabilitation and Ergonomics, Via per Revislate 13, Veruno, Italy.
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Stavrou D, Haik J, Weissman O, Goldan O, Tessone A, Winkler E. Patient and observer scar assessment scale: how good is it? J Wound Care 2009; 18:171-6. [DOI: 10.12968/jowc.2009.18.4.41610] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- D. Stavrou
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J. Haik
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O. Weissman
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O. Goldan
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A. Tessone
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E. Winkler
- Department of Plastic and Reconstructive Surgery, The Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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